Acne vulgaris, commonly referred to as acne, is a chronic inflammation of the skin that occurs most often during adolescence but can occur off and on throughout life. While acne is usually more severe during adolescence, it is often less socially acceptable to people in their 20s, 30s, 40s and 50s. The skin eruptions most often appear on the face, chest, back and upper arms and are more common in males than females.

• Blackheads–black dots the size of a pinhead
• Whiteheads–fine red bumps often more easily felt than seen
• Redness and inflamed skin–these lesions may lead to pigmentary (color) changes but they usually do not scar
• Pustules–lesions filled with pus
• Cysts–large, firm, swollen lesions found in severe acne
• Abscesses–infected lesions that are swollen, tender, inflamed and filled with pus also seen in severe acne. These lesions often scar, and the prevention or reduction of these lesions is a main goal of acne therapy.

Most cases of acne respond well to treatment and will likely improve once adolescence is over. Even with adequate treatment, acne will tend to flare up from time to time. Permanent scarring is one of the most serious consequences of acne. People with well-controlled acne tend to have more self-confidence, do better in school and get better jobs.

Oil glands in the skin become plugged for reasons unknown but during adolescence, sex-hormone changes play some role. When oil backs up in the plugged gland, bacteria normally present on the skin causes inflammation. Acne is NOT caused by certain foods, poor hygiene or masturbation. Cleaning the skin is an important part of acne therapy, but overly aggressive scrubbing can make acne appear worse. Sexual activity has no effect on acne. A family history of acne may predict if an individual will get acne and the severity of a person’s case. Currently, acne cannot be prevented, but it can usually be effectively controlled.

• Hot or cold temperatures
• Emotional stress
• Oily skin
• Endocrine (hormone) disorders
• Drugs such as cortisones or male hormones
• Some cosmetics

If your skin is oily, gently clean face with a fresh, clean wash cloth using unscented soap for 3-5 minutes; an antibacterial soap may work better. A previously used wet washcloth will harbor bacteria. Don’t aggressively scrub tender lesions as this may spread infection or cause inflammation; be gentle. Rinse the soap off for a good 1-2 minutes. Dry the face carefully with a clean towel. This regimen may need to be adjusted according to skin type and medications used for acne.

• Shampoo hair at least twice a week, more often usually is better. Keep hair off of the face even while sleeping, as hair can spread oil and bacteria. If you have dandruff, use a dandruff shampoo. Avoid cream hair rinses.
• Wash sweat and skin oil off as soon as possible after sweating and exercising.
• Use thinner, water-based cosmetics instead of the heavier oil-based ones. It should say on the label non-acnegenic or non-comedogenic.
• Avoid skin moisturizers unless recommended by your doctor; only use these if your skin is dry. Again, these should be non-acnegenic or non-comedogenic.
• Do not squeeze, pick, rub or scratch your skin or the acne lesions. This may damage the skin, causing scarring, and delay healing of the acne. Only a doctor should remove blackheads.
• Refrain from resting your face on your hands while reading, studying or watching TV
• Try to avoid pressing the phone receiver on you chin while talking on the phone.
• Do not use the sun to treat acne.

• Retinoids such as Tretinoin, Adapalene, Tazoratene
• Azeleic acid
• Benzoyl peroxid
• Topical dapsone
• Oral or topical antibiotics
• Cortisone injections into acne lesions
• Oral contraceptives
• Isotretinoin

While isotretinoin is the most powerful drug used to treat acne it needs to be monitored carefully. A special program called iPledge is required if you are to be considered for that medicine. Isotretinoin is not appropriate for most acne patients. Dr. Gross can discuss if this medicine is right for you.

• Microdermabrasion (Parisian Peel)
• Blue light laser
• Chemical peels
• Dermabrasion
• Acne surgery
• Photodynamic therapy
• Fraxel laser

The contents of PiedmontDermatology.com are for general educational and informational purposes only and not to be misconstrued as treatment advice or medical diagnosis. This information does not replace the advice of a physician, nor does it imply a physican – patient relationship between the reader, Dr. Gross and Piedmont Dermatology Center.